CDC Appropriations Documents, FY 2008
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© 2008 FedTrain, Inc. C-1
Extracted and annotated by FedTrain, Inc. Atlanta, GA
CDC Appropriations Documents, FY 2008
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Table of Contents
Item / PageExamples of congressional language in selected reports. / 3
FY 2008 House Report H.R. 110-231 / 5
FY 2008 Senate Report S.R. 110-107 / 42
FY 2008 House-Senate Conference Report H.R. 110-424 / 87
FY 2008 Omnibus Appropriations Act, P. L. 110-161, December 26, 2007 / 111
Centers for Disease Control and Prevention Disease Control, Research and Training Appropriation
Editors note: As a result of a Department of HHS Inspector General audit of CDC’s accounting practices of the Chronic Fatigue Program and the Hantavirus Program a number of articles were published in national new media publications, including the Washington Post. The Congress was upset that the then CDC Director had acted to obligate funds “inconsistent with committee expectations”. The impacts included (in addition to the obvious blemish on the agency’s financial management reputation) increased oversight and direction by the committees. Some samples of the written matters follow:
Senate Report 106-293 – FY01 Appropriations Bill
Financial Management Review- The Committee was extremely concerned to learn of inconsistencies in funding of the Hantavirus Program, as well as the funding for the Chronic Fatigue Syndrome (CFS) during fiscal years 1995-1998. The amounts obligated in specific disease areas varied from congressional expectations and understandings.
The GAO at the Committee's request is conducting an extensive review to develop procedures and practices that could mitigate or prevent future occurrences. In addition to the GAO review, the Committee was pleased to learn that CDC has also obtained the services of a professional management consultant to conduct a full-scope management review of CDC's general fiscal management practices, to document practices throughout the budget allocation and execution process and to suggest improvements, based on industry and other Federal agency best practices. The Committee recommends that this professional management firm and GAO closely collaborate to assure a thorough and efficient review.
In conducting this independent management review, the Committee directs CDC to review the entire continuum of fiscal management activities, beginning from line item Congressional appropriations, CDC's budget allocation process, and budget executive activities of CDC's organizational components, centers, Institutes and offices.
House of Representatives Report 107-229–FY02 Appropriations Bill
The Committee considers the table accompanying this report to be determinative of the CDC budget. Funds should be apportioned and allocated consistent with the table, and any changes in funding are subject to the normal notification procedures. (Editors note: The ‘table’ (actually an Excel-type spreadsheet) itemized approved budget amounts for every program and subprogram and many of the subprogram activities for CDC’s operations. The clear inference was that the committee intended to restrict the Director’s prerogatives with regard to reprogramming funds from one activity to another. This exact language continued to appear in House of Representatives Appropriations Committee Reports as late as FY06.)
Senate Report 107-216 – FY03 Appropriations Bill
Chronic Fatigue Syndrome (CFS) - The Committee is pleased that CDC has branched into new and important areas of CFS research and medical education in the first 3 years of the 4-year period in which $12,900,000 is being restored to the CFS program at CDC.Since approximately half the funds remain, the Committee instructs CDC to extend the payback period by 1 year, through fiscal year 2004. The Committee further expects that CDC will provide sufficient funding, including funds allocated through the payback program, to accelerate its CFS research plan to identify the causes, risk factors, diagnostic markers, natural history and economic impact of CFS; to create a CFS patient registry; and to educate health care providers about the detection, diagnosis and management of CFS.[Editors note: The payback period was extended until FY05 in the Senate Report for FY04. It took until FY06 before CDC was able to fully restore the required $13 million].
Conference Report 110-424 –FY08 Appropriations Bill
The conferees note that in September 2007, CDC realigned its budget through a reprogramming and transfer of funds at the program, project, and activity level. The Secretary communicated his intent that the realignment of funds be permanent. Funding levels proposed in the House- and Senate-passed bills did not reflect these changes because the request for reprogramming came after initial House and Senate Committee action on the fiscal year 2008 appropriations bills. Funding levels provided in the conference agreement make the funding realignment permanent. The conferees expect CDC to adhere to enacted funding levels in fiscal year 2008 and to not tap or assess program activities for unrelated purposes.
P.L. 110-161, FY 2008 Omnibus Appropriations Act, December 26, 2007.
See Page 118 below for language in SEC. 222. regarding certain CDC expenditures.
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© 2008 FedTrain, Inc. C-1
Extracted and annotated by FedTrain, Inc. Atlanta, GA
CDC Appropriations Documents, FY 2008House of Representatives
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Report 110-231
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2008
R E P O R T
of the
COMMITTEE ON APPROPRIATIONS
together with
MINORITY AND ADDITIONAL VIEWS
[to accompany H.R. 3043]
July 13, 2007- Committed to the Committee of the Whole House on the State of the Union and ordered to be printed
* * * * * * * Portions Omitted * * * * * * *
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION,
AND RELATED AGENCIES APPROPRIATIONS BILL, 2008
* * * * * * * Portions Omitted * * * * * * *
CENTERS FOR DISEASE CONTROL AND PREVENTION
DISEASE CONTROL, RESEARCH, AND TRAINING
The Committee provides a program level total of $6,457,832,000 for the Centers for Disease Control and Prevention (CDC), which is $255,160,000 above the fiscal year 2007 funding level and $475,181,000 above the budget request. Of the funds provided, $316,079,000 shall be derived from evaluation set-aside funds available under section 241 of the Public Health Service Act, which is $50,979,000 above the fiscal year 2007 set-aside and $50,079,000 above the requested set-aside. The Committee includes an undistributed reduction of $2,000,000 within this account.
With the exception of the public health and health services block grant, which has a statutorily-determined formula distribution, all funds provided in this appropriation are awarded via competitive grant/cooperative agreement or contract, administratively-determined formula, or are awarded on a sole-source basis where only one eligible partner is determined. Funding is typically awarded to States, localities, public health departments, higher education institutions, private industry, or nonprofit voluntary groups or associations and is reviewed by outside peer reviewers.
The CDC assists State and local health authorities and other non-governmental health-related organizations to understand, control, and reduce disease and other health problems. The activities of CDC focus on several major priorities, including providing core public health functions, responding to urgent public health threats, monitoring the nation's health using scientific methods, building the nation's public health infrastructure, promoting health throughout each life-stage, and providing leadership in the implementation of nationwide prevention strategies to encourage responsible behavior and adoption of lifestyles that are conducive to good health.
Infectious diseases
The Committee provides a program level of $1,913,302,000 for infectious diseases, which is $109,071,000 above the fiscal year 2007 funding level and $118,934,000 above the budget request. Of the funds provided, $12,794,000 shall be derived from evaluation set-aside funds available under section 241 of the Public Health Service Act, as proposed in the budget request.
Immunization and respiratory diseases
The Committee provides a program level of $636,159,000 for immunization and respiratory diseases, which is $68,155,000 over the fiscal year 2007 funding level and $91,182,000 above the budget request. Of the amount provided, $12,794,000 is to be derived from section 241 evaluation set-aside funds, as provided in fiscal year 2007 and as proposed in the request. In addition, the current vaccines for children program is expected to provide $2,761,957,000 in vaccine purchases and distribution support in fiscal year 2008, for a total of $3,398,116,000 for immunization and respiratory diseases activities in fiscal year 2008.
In fiscal year 2007, CDC reorganized within the coordinating center for infectious diseases to combine activities related to respiratory diseases with immunization activities. In addition, a new influenza division was created within this new national center for immunization and respiratory diseases.
Immunization project grants are awarded to States and local agencies for planning, developing, and conducting childhood and adult immunization programs including enhancement of the vaccine delivery infrastructure. CDC directly maintains a stockpile of vaccines, supports consolidated purchase of vaccines for State and local health agencies, and conducts surveillance, investigations, and research into the safety and efficacy of new and presently used vaccines. The Committee notes that there are other Federal programs that provide immunizations to children, including the State children's health insurance program (SCHIP), the maternal and child health block grant, and community health centers.
The Committee recommends $516,273,000 for the immunization program authorized by section 317 of the Public Health Service Act, which is $58,750,000 above the fiscal year 2007 funding level and $91,150,000 above the budget request. The Committee is aware that prior to 2000 and the introduction of new vaccines, such as the recent human papillomavirus vaccine, the 317 immunization program was adequately providing vaccines to children and adolescents traditionally dependent on the public sector for support, but who were not eligible for the vaccines for children program.
Currently, the 317 immunization program is falling far short of the need. The current estimate of the cost to fully immunize a female through age 18 is over $1,240 and for a male it is over $936--this compares with a total cost of $186 for females and males in 1999. As a result of these increased vaccine costs, the number of children receiving vaccines under the 317 program has fallen from 747,000 in 1999 to an estimated 279,000 in 2006. The Committee recommendation is the first step toward the goal of fully immunizing all eligible individuals. The additional funding included above the fiscal year 2007 appropriation will allow approximately 42,000 additional children and adolescents to receive the full vaccine schedule compared to the estimated number of those who will be served in 2007.
The Committee is concerned that immunization levels for vaccines routinely recommended for many adolescents and adults lag far behind coverage levels for vaccines for children. The Committee understands that CDC led a process during the early 1990s that resulted in the development of immunization action plans (IAPs) in all 50 States and in many major urban areas to achieve 90 percent immunization coverage for vaccines recommended for young children. These IAPs were the result of community planning efforts led by State and local health departments and included detailed actions thought to be needed to achieve coverage goals, activities that could be undertaken with available resources and estimates of the resources required for such efforts. The Committee believes that while maintaining the commitment to and the coverage levels for children, a similar process may be useful for reaching adolescent and adult immunization goals, and encourages CDC to provide funding to States or local organizations that receive section 317 immunization grant funds to develop community adolescent and adult immunization planning demonstrations to achieve 90 percent immunization coverage for vaccines routinely recommended for adolescents and adults. These models should include existing and new efforts planned within existing resources; new activities needed and estimates for those needs.
The Committee is pleased with the report on the section 317 immunization program that CDC provided and requests that the report be updated and promptly submitted by February 1, 2008, to reflect fiscal year 2009 cost estimates. The updated report also should include an estimate of optimum State and local operations funding as well as CDC operations funding needed relative to current levels to conduct and support childhood, adolescent, and adult programs. This estimate should include the cost of vaccine administration; surveillance and assessment of changes in immunization rates; vaccine storage, handling and quality assurance; implementation of centralized vaccine distribution and other vaccine business improvement practices; needs to support provider and public outreach and education on new vaccines; identification of barriers to immunization and strategies to address such barriers; maintenance, utilization, and enhancement of immunization information systems, including integration with public health preparedness and other public health information technology systems; innovative strategies to increase coverage rates in hard-to-reach populations and geographic pockets of need; vaccine safety; and other non-vaccine resource needs of a comprehensive immunization program. Each of these activities is critical to ensuring the delivery of life-saving vaccines to our nation and has been under-funded in recent years.
The Committee recommends $82,575,000 for immunization and respiratory diseases program operations, which is $19,759,000 above the fiscal year 2007 funding level and $32,000 above the budget request. This funding supports vaccine tracking, vaccine safety, and prevention activities. Included within the total is $19,800,000 to provide funds to States to increase demand for influenza vaccine with the intention that by doing so, U.S. vaccine production capacity also will be stimulated.
The Committee recommends $37,311,000 for activities related to preparing for and responding to a pandemic influenza, which is $10,354,000 below the fiscal year 2007 funding level and the same as the budget request. Included within this total is $19,800,000 to develop a repository of pandemic virus reference strains for manufacturing and $14,850,000 to increase the stock of diagnostic reagents for influenza.
Vaccine safety datalink- In fiscal year 2006, the Committee requested that the National Institute of Environmental Health Sciences (NIEHS) convene a panel of expert, independent researchers for the purpose of exploring the possibility of using the CDC's vaccine safety datalink (VSD) to conduct a study that could `identify or rule out any association between thimerosal exposure in pediatric vaccines and increased rates of autism.' The expert panel convened in May 2006 and issued a report, which recommended that gaps and uncertainties in the VSD be addressed prior to the consideration of further studies of autism and thimerosal using the VSD. Given that the VSD ten-year contract totals more than $120,000,000, the Committee urges CDC to report to the House Committee on Appropriations no later than March 1, 2008 on its response to the NIEHS recommendations. This report should include information about current and ongoing CDC studies that address the potential association between thimerosal exposure in pediatric vaccines and neurodevelopmental disorders including autism.
HIV/AIDS, viral hepatitis, STD and TB prevention
The Committee provides $1,042,303,000 for HIV/AIDS, viral hepatitis, sexually transmitted diseases (STD), and tuberculosis (TB) prevention, which is $32,112,000 above the fiscal year 2007 funding level and $14,495,000 below the request.
Within the total, $715,463,000 is for domestic HIV/AIDS prevention and research, which is $17,413,000 above the fiscal year 2007 funding level and $29,644,000 below the budget request. This funding level supports HIV research, surveillance, epidemiologic and laboratory studies, and prevention activities. CDC provides funds to State and local health departments to develop and implement integrated community prevention plans. The Committee supports the domestic HIV/AIDS initiative and provides $63,000,000 for the testing component of the initiative within CDC, which is $18,000,000 more than the fiscal year 2007 funding level and $30,000,000 less than the budget request. The Committee does not provide a set-aside within this funding for the early diagnosis grant program and notes that currently no States have adopted the HIV testing policies designated for eligibility to receive funding under this new authorization.
Within the total, $18,615,000 is for the viral hepatitis program, which is $1,000,000 more than the fiscal year 2007 funding level and $1,025,000 more than the budget request. The division of viral hepatitis provides the scientific and programmatic foundation for the prevention, control, and elimination of hepatitis virus infections in the U.S.
Within the total, $157,537,000 is for the sexually transmitted diseases (STD) prevention program, which is the same as the fiscal year 2007 funding level and $227,000 more than the budget request. The division of STD prevention provides national leadership through research, policy development, and support of effective services to prevent sexually transmitted diseases and their complications such as infertility, adverse outcomes of pregnancy, and reproductive tract cancer. CDC assists health departments, health-care providers, and non-governmental organizations and collaborates with other governmental entities through the development, syntheses, translation, and dissemination of timely, science-based information; the development of national goals and science-based policy; and the development and support of science-based programs that meet the needs of communities.
Within the total, $150,688,000 is for the tuberculosis program, which is $13,699,000 more than the fiscal year 2007 funding level and $13,897,000 more than the budget request. The TB program provides grants to States and large cities for a broad range of tuberculosis control activities. In addition, the CDC supports State and local laboratories and conducts research, epidemiological investigations, and education and training seminars.
HIV/AIDS in minority communities- Funds are provided within the total for domestic HIV/AIDS prevention and research programs to support activities that are targeted to address the growing HIV/AIDS epidemic and its disparate impact on communities of color, including African Americans, Latinos, Native Americans, Asian Americans, Native Hawaiians, and Pacific Islanders.
Hepatitis B.--The Committee applauds CDC's efforts to develop and implement a new strategy to screen individuals at risk for chronic hepatitis B. As only approximately one-third of individuals with hepatitis B are aware of their condition, the Committee urges CDC to continue to collaborate with the National Institute of Diabetes and Digestive and Kidney Diseases in the development of a public health strategy to expand the screening of individuals at risk for chronic hepatitis B. In addition, the Committee notes that accurate national statistics are lacking as to the number of Americans infected with hepatitis B, as existing population-based surveys have not included Asian/Pacific islander groups in whom hepatitis B is by far the most common. The Committee is aware that there are now six pharmaceutical products available for the treatment of hepatitis B and that three of them have become available in the last two years. The significant improvement in treatment options increases the timeliness of an aggressive screening program for hepatitis B.